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Oommen SG, Man RK, Talluri K, Nizam M, Kohir T, Aviles MA, Nino M, Jaisankar LG, Jaura J, Wannakuwatte RA, Tom L, Abraham J, Siddiqui HF. Heart Failure With Improved Ejection Fraction: Prevalence, Predictors, and Guideline-Directed Medical Therapy. Cureus 2024; 16:e61790. [PMID: 38975458 PMCID: PMC11227107 DOI: 10.7759/cureus.61790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Recently, a new category of heart failure with improved ejection fraction (HFimpEF) has emerged in the classification system. This is defined as the subgroup of patients with heart failure with reduced ejection fraction (HFrEF) whose left ventricular ejection fraction has recovered partially or completely, with no specific cut-off values established yet in the guidelines. In our review, we aim to provide an overview of prevalence, predictors, mechanism of remodeling, and management strategies regarding HFimpEF. These patients constitute a sizeable cohort among patients with reduced ejection fraction. Certain patient characteristics including younger age and female gender, absence of comorbid conditions, low levels of biomarkers, and non-ischemic etiology were identified as positive predictors. The heart undergoes significant maladaptive changes post failure leading to adverse remodeling influenced etiology and duration. Goal-directed medical therapy including beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs) have notably improved cardiac function by inducing reverse remodeling. Despite a more favorable prognosis compared to HFrEF, patients with improved ejection fraction (EF) still face clinical events and reduced quality of life, and remain at risk of adverse outcomes. Although the evidence is scarce, it is advisable to continue treatment modalities despite improvement in EF, including device therapies, to prevent relapse and clinical deterioration. It is imperative to conduct further research to understand the mechanism leading to EF amelioration and establish guidelines to identify and direct management strategies.
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Affiliation(s)
- Sheethal G Oommen
- Psychiatry, Grigore T. Popa University of Medicine and Pharmacy, Iași, ROU
| | - Ruzhual K Man
- Research, Lady Hardinge Medical College, Mumbai, IND
| | - Keerthi Talluri
- Department of Medicine, Ganni Subba Lakshmi Medical College, Rajahmundry, IND
| | - Maryam Nizam
- Emergency Department, Valaichennai Base Hospital, Valaichennai, LKA
| | - Tejashwini Kohir
- Department of Medicine, Ganni Subba Lakshmi Medical College, Rajahmundry, IND
| | | | | | | | - Jashan Jaura
- General Practice, Max Super Speciality Hospital, Bathinda, Bathinda, IND
| | | | - Leo Tom
- Internal Medicine, Kowdoor Sadananda Hegde Medical Academy, Mangalore, IND
| | - Jeby Abraham
- General Medicine, Yenepoya Medical College, Mangalore, IND
| | - Humza F Siddiqui
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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2
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Crnko S, Brugts JJ, Veenis JF, de Jonge N, Sluijter JPG, Oerlemans MIF, van Laake LW. Morning pulmonary artery pressure measurements by CardioMEMS are most stable and recommended for pressure trends monitoring. Neth Heart J 2021; 29:409-414. [PMID: 34114177 PMCID: PMC8271080 DOI: 10.1007/s12471-021-01590-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/25/2022] Open
Abstract
AIMS The CardioMEMS HF system is used to measure pulmonary artery (PA) pressures of patients with heart failure (HF). The goal of this study was to determine the impact of time in the daily PA pressure measurements, considering variance and influence of circadian rhythms on cardiovascular pathophysiology. METHODS AND RESULTS The study included 10 patients with HF with reduced ejection fraction (LVEF < 40%; New York Heart Association class III). Individual daily PA pressures were obtained by CardioMEMS sensors, per protocol, measured up to six times throughout the day, for a period of 5 days. Differences between variation of morning versus evening PA pressures were compared with Wilcoxon signed-rank test. Mean PA pressures (mPAP) increased from a morning value of 19.1 ± 2 mm Hg (8 am; mean ± standard error of the mean [SEM]) to 21.3 ± 2 mm Hg late in the evening (11 pm; mean ± SEM). Over the course of 5 days, evening mPAP exhibited a significantly higher median coefficient of variation than morning mPAP (14.9 (interquartile range [IQR] 7.6-21.0) and 7.0 (IQR 5.0-12.8) respectively; p = 0.01). The same daily pattern of pressure variability was observed in diastolic (p = 0.01) and systolic (p = 0.04) pressures, with diastolic pressures being more variable than systolic at all time points. CONCLUSIONS Morning PA pressure measurements yield more stable values for observing PA trends. Patients should thus be advised to consistently perform their daily PA pressure measurements early in the morning. This will improve reliability and interpretation of the CardioMEMS management, indicating true alterations in the patient's health status, rather than time-of-day-dependent variations.
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Affiliation(s)
- S Crnko
- Department of Cardiology and Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Centre, Circulatory Health Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J Brugts
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J F Veenis
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - N de Jonge
- Department of Cardiology and Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P G Sluijter
- Department of Cardiology and Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Centre, Circulatory Health Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
| | - M I F Oerlemans
- Department of Cardiology and Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W van Laake
- Department of Cardiology and Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
- Regenerative Medicine Centre, Circulatory Health Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands.
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Karakus A, Uguz B. Approach to decongestion therapy in patients with acute decompensated heart failure: the echocardiography guided strategy. KARDIOLOGIIA 2021; 61:76-82. [PMID: 33715612 DOI: 10.18087/cardio.2021.2.n1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/03/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
Goal The E / (Ea×Sa) index is an echocardiographic parameter to determine a patient's left ventricular filling pressure. This study aims to determine the safety and efficacy of the echocardiographic E / (Ea×Sa) index guided diuretic therapy compared to urine output (conventional) guided diuretic treatment.Material and Methods In this cross-sectional study, patients with heart failure with reduced ejection fraction (HFrEF) who were hospitalized due to acute decompensation episode were consecutively allocated in a 1:1 ratio to monitoring arms. The diuretic dose, which provided 20 % reduction in the E / (Ea×Sa) index value compared to initial value, was determined as adequate dose in echocardiography guided monitoring group. The estimated glomerular filtration rate (eGFR), change in weight, NT pro-BNP level and dyspnea assessment on visual analogue scale (VAS) were analyzed at the end of the monitoring.Results Although the similar doses of diuretics were used in both groups, the patients with E / (Ea×Sa) index guided strategy had the substantial lower NT pro-BNP level within 72 hours after diuretic administration (2172 vs.2514 pg / mL, p= 0.036). VAS score on dyspnea assessment was significantly better in the patients with E / (Ea×Sa) index guided strategy (52 vs. 65; p= 0.04). And, in term of body weight loss (4.93 vs.5.21 kg, p=0.87) and e-GFR (54.58±8.6 vs. 52.65±9.1 mL / min / 1.73 m2p=0.74) in both groups are associated with similar outcomes. In both groups, there was no worsening renal function and electrolyte imbalance that required stopping or decreasing loop diuretic dosing.Conclusions The E / (Ea×Sa) index guidance might be a safe strategy for more effective diuretic response that deserves consideration for selected a subgroup of acute decomposed HFrEF patients.
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Affiliation(s)
- Alper Karakus
- Department of Cardiology, Besni State Hospital, Adıyaman, Turkey
| | - Berat Uguz
- Department of Cardiology, Bursa City Hospital, Bursa, Turkey
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4
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Abstract
Heart failure is a complex clinical syndrome and represents the final path of numerous heart diseases. Coronary artery disease is recognized as the primary risk factor for heart failure development, being the main etiological factor in more than 50% of heart failure patients in North America and Europe. Regardless of overt coronary artery disease, myocardial ischemia is a common finding in failing hearts, likely due to structural or functional coronary circulation alterations. Ischemia is a self-propagating process which irreversibly impairs the cardiac function and negatively impacts prognosis. Thus, a better and thorough understanding of myocardial ischemia pathophysiology in heart failure would likely lead to significantly improved outcomes in these patients. This review aims to describe the mechanisms of myocardial ischemia and coronary artery disease in heart failure, focusing on coronary circulation dysfunctions due to increased parietal stress or non-obstructive coronary disease, and discussing the association and management of coronary artery disease in patients with heart failure.
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Affiliation(s)
- Beniamino R Pagliaro
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Francesco Cannata
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
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5
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Palazzuoli A, Evangelista I, Nuti R. Congestion occurrence and evaluation in acute heart failure scenario: time to reconsider different pathways of volume overload. Heart Fail Rev 2020; 25:119-131. [PMID: 31628648 DOI: 10.1007/s10741-019-09868-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although congestion is considered to be the main reason for hospital admission in patients with acute heart failure, a simplistic view considering idro saline retention and total body volume accumulation did not provide convincing data. Clinical congestion occurrence is often the tip of the iceberg of several different mechanisms ranging from increased filling pressure to extravascular fluid accumulation and blood flow redistribution. Therefore, the clinical evaluation is often restricted to a simple physical examination including few and inaccurate signs and symptoms. This superficial approach has led to contradictory data and patients have not been evaluated according to a more realistic clinical scenario. The integration with new diagnostic ultrasonographic and laboratory tools would substantially improve these weaknesses. Indeed, congestion could be assessed by following the most recognized HF subtypes including primitive cardiac defect, presence of right ventricular dysfunction, and organ perfusion. Moreover, there is a tremendous gap regarding the interchangeable concept of fluid retention and redistribution used with a univocal meaning. Overall, congestion assessment should be revised, considering it as either central, peripheral, or both. In this review, we aim to provide different evidence regarding the concept of congestion starting from the most recognized pathophysiological mechanisms of AHF decompensation. We highlight the fact that a better knowledge of congestion is a challenge for future investigation and it could lead to significant advances in HF treatment.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Viale Bracci, Siena, 53100, Italy.
| | - Isabella Evangelista
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Viale Bracci, Siena, 53100, Italy
| | - Ranuccio Nuti
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Viale Bracci, Siena, 53100, Italy
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6
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Prognostic Value of QRS Duration among Patients with Cardiogenic Shock Complicating Acute Heart Failure: Data from the Korean Acute Heart Failure (KorAHF) Registry. INTERNATIONAL JOURNAL OF HEART FAILURE 2020; 2:121-130. [PMID: 36263287 PMCID: PMC9536664 DOI: 10.36628/ijhf.2019.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022]
Abstract
Background and Objectives Prolonged QRS duration is associated with poor outcomes in patients with chronic heart failure (HF). However, the prognostic value of QRS duration in patients with cardiogenic shock complicating acute HF remains unknown. We evaluated the hypothesis that prolonged QRS duration may be associated with short-term mortality among acute HF patients with cardiogenic shock (CS). Methods From March 2011 through December 2013, a total of 5,625 acute HF patients were consecutively enrolled in ten tertiary university hospitals. Among them, we analyzed patients who presented with CS. Patients were divided into three groups by QRS duration cutoff values of 130 and 150 ms. The primary endpoint was 30-day in-hospital mortality. Results Two hundred eleven patients presented with CS at admission and those with available electrocardiograms were included in this analysis. There were 35 patients with QRS durations of 150 ms or above, 30 patients with QRS durations between 130 ms and 150 ms, and 146 patients with QRS durations below 130 ms. The 30-day all cause in-hospital mortality rates were 43.7%, 33.1%, and 24.9%, respectively. After multivariate adjustment, severe prolonged QRS duration was a significant prognostic factor for 30-day in-hospital mortality (hazard ratio, 1.909; 95% confidence interval, 1.024–3.558; p=0.042). Conclusions Prolonged QRS duration was associated with a higher risk of 30-day in-hospital mortality among patients with acute HF who presented with CS. Trial Registration ClinicalTrials.gov Identifier: NCT01389843
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7
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Farmakis D, Agostoni P, Baholli L, Bautin A, Comin-Colet J, Crespo-Leiro MG, Fedele F, García-Pinilla JM, Giannakoulas G, Grigioni F, Gruchała M, Gustafsson F, Harjola VP, Hasin T, Herpain A, Iliodromitis EK, Karason K, Kivikko M, Liaudet L, Ljubas-Maček J, Marini M, Masip J, Mebazaa A, Nikolaou M, Ostadal P, Põder P, Pollesello P, Polyzogopoulou E, Pölzl G, Tschope C, Varpula M, von Lewinski D, Vrtovec B, Yilmaz MB, Zima E, Parissis J. A pragmatic approach to the use of inotropes for the management of acute and advanced heart failure: An expert panel consensus. Int J Cardiol 2019; 297:83-90. [PMID: 31615650 DOI: 10.1016/j.ijcard.2019.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/14/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022]
Abstract
Inotropes aim at increasing cardiac output by enhancing cardiac contractility. They constitute the third pharmacological pillar in the treatment of patients with decompensated heart failure, the other two being diuretics and vasodilators. Three classes of parenterally administered inotropes are currently indicated for decompensated heart failure, (i) the beta adrenergic agonists, including dopamine and dobutamine and also the catecholamines epinephrine and norepinephrine, (ii) the phosphodiesterase III inhibitor milrinone and (iii) the calcium sensitizer levosimendan. These three families of drugs share some pharmacologic traits, but differ profoundly in many of their pleiotropic effects. Identifying the patients in need of inotropic support and selecting the proper inotrope in each case remain challenging. The present consensus, derived by a panel meeting of experts from 21 countries, aims at addressing this very issue in the setting of both acute and advanced heart failure.
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Affiliation(s)
- Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus; Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dept. of Clinical Sciences and Community Health - Cardiovascular Section, University of Milan, Milan, Italy
| | - Loant Baholli
- Medizinische Klinik Mitte - Schwerpunkte Kardiologie und Internistische Intensivmedizin, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Andrei Bautin
- Department of Anesthesiology, Almazov National Medical Research Center, Saint Petersburg, Russia
| | - Josep Comin-Colet
- Heart Diseases Institute, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario de A Coruña (CHUAC)-CIBERCV, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña (UDC), A Coruña, Spain
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, 'La Sapienza' University of Rome, Rome, Italy
| | - Jose Manuel García-Pinilla
- Heart Failure and Familial Cardiopathies Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Francesco Grigioni
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Finn Gustafsson
- Cardiology Dept., Rigshospitalet, University of Copenhagen, Copengahen, Denmark
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Antoine Herpain
- Department of Intensive Care, Experimental Laboratory of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Efstathios K Iliodromitis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kristjan Karason
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matti Kivikko
- Department of Cardiology S7, Jorvi Hospital, Espoo, Finland; Critical Care Proprietary Products, Orion Pharma, Espoo, Finland
| | - Lucas Liaudet
- Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois et Faculté de Biologie et Médecine, Lausanne, Switzerland
| | - Jana Ljubas-Maček
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Marco Marini
- Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona, Italy
| | - Josep Masip
- Intensive Care Dpt. Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain; Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France
| | - Maria Nikolaou
- Department of Cardiology, General Hospital "Sismanogleio-Amalia Fleming", Greece
| | - Petr Ostadal
- Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
| | - Pentti Põder
- Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia
| | - Piero Pollesello
- Critical Care Proprietary Products, Orion Pharma, Espoo, Finland
| | - Eftihia Polyzogopoulou
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerhard Pölzl
- Universitätsklinik für Innere Medizin III, Medizinsche Universität, Innsbruck, Austria
| | - Carsten Tschope
- Charité, University Medicine Berlin, Campus Virchow Klinikum (CVK), Department of Cardiology, Germany; BCRT, Berlin Institute of Health for Center for Regenerative Therapies, Berlin, Germany
| | - Marjut Varpula
- Department of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Dirk von Lewinski
- Department of Cardiology, Myokardiale Energetik und Metabolismus Research Unit, Medical University, Graz, Austria
| | - Bojan Vrtovec
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - John Parissis
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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8
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Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, Testani JM, Tang WHW, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic PM, Ruschitzka F, Coats AJ. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21:137-155. [PMID: 30600580 DOI: 10.1002/ejhf.1369] [Citation(s) in RCA: 578] [Impact Index Per Article: 115.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/14/2018] [Accepted: 10/27/2018] [Indexed: 12/11/2022] Open
Abstract
The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion.
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Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium.,University of Hasselt, Hasselt, Belgium
| | - Kevin Damman
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Alexandre Mebazaa
- University of Paris Diderot, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, U 942 Inserm, F-CRIN INI-CRCT, Paris, France
| | | | - Pieter Martens
- Ziekenhuis Oost Limburg, Genk, Belgium.,University of Hasselt, Hasselt, Belgium
| | | | | | | | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Clinique 1433 and Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT, Nancy, France
| | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, Athens, Greece.,University of Cyprus, Nicosia, Cyprus
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9
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Choi HM, Park MS, Youn JC. Update on heart failure management and future directions. Korean J Intern Med 2019; 34:11-43. [PMID: 30612416 PMCID: PMC6325445 DOI: 10.3904/kjim.2018.428] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/09/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is an important cardiovascular disease because of its increasing prevalence, significant morbidity, high mortality, and rapidly expanding health care cost. The number of HF patients is increasing worldwide, and Korea is no exception. There have been marked advances in definition, diagnostic modalities, and treatment of HF over the past four decades. There is continuing effort to improve risk stratification of HF using biomarkers, imaging and genetic testing. Newly developed medications and devices for HF have been widely adopted in clinical practice. Furthermore, definitive treatment for end-stage heart failure including left ventricular assist device and heart transplantation are rapidly evolving as well. This review summarizes the current state-of-the-art management for HF and the emerging diagnostic and therapeutic modalities to improve the outcome of HF patients.
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Affiliation(s)
- Hong-Mi Choi
- Division of Cardiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Myung-Soo Park
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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10
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Mullens W, Verbrugge FH, Nijst P, Martens P, Tartaglia K, Theunissen E, Bruckers L, Droogne W, Troisfontaines P, Damman K, Lassus J, Mebazaa A, Filippatos G, Ruschitzka F, Dupont M. Rationale and design of the ADVOR (Acetazolamide in Decompensated Heart Failure with Volume Overload) trial. Eur J Heart Fail 2018; 20:1591-1600. [DOI: 10.1002/ejhf.1307] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/11/2018] [Accepted: 08/02/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost-Limburg; Genk Belgium
- Hasselt University, Diepenbeek/Hasselt; Belgium
| | | | | | | | | | | | | | | | | | - Kevin Damman
- University Medical Center Groningen; Groningen The Netherlands
| | - Johan Lassus
- Helsinki University Central Hospital; Helsinki Finland
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11
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Van Aelst LNL, Mebazaa A. Beyond left ventricular ejection fraction there is a right heart that pumps: reply. Eur J Heart Fail 2018; 20:1076-1077. [PMID: 29624796 DOI: 10.1002/ejhf.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lucas N L Van Aelst
- Department of Cardiovascular Sciences KU Leuven, Campus Gasthuisberg O&N1, Leuven, Belgium.,Department of Cardiology, Hôpital Lariboisière, Paris, France.,U942 INSERM, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexandre Mebazaa
- U942 INSERM, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Anesthesia and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
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12
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Affiliation(s)
- V. Bistola
- Heart Failure Unit; 2nd Department of Cardiology; Attikon University Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - O. Chioncel
- Institute of Emergency for Cardiovascular Diseases ‘Prof. C.C. Iliescu’; University of Medicine and Pharmacy Carol Davila; Bucuresti Romania
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13
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Abstract
PURPOSE OF REVIEW Acute decompensated heart failure is a serious and common condition where close monitoring of symptoms, vital signs, haemodynamic and other markers are needed after the patient is admitted to hospital as the in-hospital outcome is poor. This review focuses on advances in the assessment and monitoring of these patients. RECENT FINDINGS The adoption of the CHAMP acronym to identify precipitating factors and of the classification using wet-warm, wet-cold, dry-warm and dry-cold categories is an improvement regarding assessment. Although the outcome of acute decompensated heart failure has remained poor with no new treatments found for a number of years, a structured approach to assessment and monitoring is now available.
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Affiliation(s)
- Danish Ali
- Department of Cardiology, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK.
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Breedt E, Lacerda L, Essop MF. Trimetazidine therapy for diabetic mouse hearts subjected to ex vivo acute heart failure. PLoS One 2017; 12:e0179509. [PMID: 28632748 PMCID: PMC5478112 DOI: 10.1371/journal.pone.0179509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/30/2017] [Indexed: 11/19/2022] Open
Abstract
Acute heart failure (AHF) is the most common primary diagnosis for hospitalized heart diseases in Africa. As increased fatty acid β-oxidation (FAO) during heart failure triggers detrimental effects on the myocardium, we hypothesized that trimetazidine (TMZ) (partial FAO inhibitor) offers cardioprotection under normal and obese-related diabetic conditions. Hearts were isolated from 12-14-week-old obese male and female diabetic (db/db) mice versus lean non-diabetic littermates (db/+) controls. The Langendorff retrograde isolated heart perfusion system was employed to establish an ex vivo AHF model: a) Stabilization phase-Krebs Henseleit buffer (10 mM glucose) at 100 mmHg (25 min); b) Critical Acute Heart Failure (CAHF) phase-(1.2 mM palmitic acid, 2.5 mM glucose) at 20 mmHg (25 min); and c) Recovery Acute Heart Failure phase (RAHF)-(1.2 mM palmitic acid, 10 mM glucose) at 100 mmHg (25 min). Treated groups received 5 μM TMZ in the perfusate during either the CAHF or RAHF stage for the full duration of each respective phase. Both lean and obese males benefited from TMZ treatment administered during the RAHF phase. Sex differences were observed only in lean groups where the phases of the estrous cycle influenced therapy; only the lean follicular female group responded to TMZ treatment during the CAHF phase. Lean luteal females rather displayed an inherent cardioprotection (without treatments) that was lost with obesity. However, TMZ treatment initiated during RAHF was beneficial for obese luteal females. TMZ treatment triggered significant recovery for male and obese female hearts when administered during RAHF. There were no differences between lean and obese male hearts, while lean females displayed a functional recovery advantage over lean males. Thus TMZ emerges as a worthy therapeutic target to consider for AHF treatment in normal and obese-diabetic individuals (for both sexes), but only when administered during the recovery phase and not during the very acute stages.
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Affiliation(s)
- Emilene Breedt
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lydia Lacerda
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M. Faadiel Essop
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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Torres-Courchoud I, Chen H. B-type natriuretic peptide and acute heart failure: Fluid homeostasis, biomarker and therapeutics. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rceng.2016.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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16
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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17
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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18
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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19
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8912] [Impact Index Per Article: 1114.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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21
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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22
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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23
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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24
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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B-type natriuretic peptide and acute heart failure: Fluid homeostasis, biomarker and therapeutics. Rev Clin Esp 2016; 216:393-398. [PMID: 26961205 DOI: 10.1016/j.rce.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/21/2016] [Indexed: 01/11/2023]
Abstract
Natriuretic peptides are a family of peptides with similar structures, but are genetically distinct with diverse actions in cardiovascular, renal and fluid homeostasis. The family consists of an atrial natriuretic peptide (ANP) and a brain natriuretic peptide (BNP) of myocardial cell origin, a C-type natriuretic peptide (CNP) of endothelial origin, and a urodilatin (Uro) which is processed from a prohormone ANP in the kidney. Nesiritide, a human recombinant BNP, was approved by the Federal Drug Administration (FDA) for the management of acute heart failure (AHF) in 2001. Human recombinant ANP (Carperitide) was approved for the same clinical indication in Japan in 1995, and human recombinant Urodilatin (Ularitide) is currently undergoing phase III clinical trial (TRUE AHF). This review will provide an update on important issues regarding the role of BNP in fluid hemostasis as a biomarker and therapeutics in AHF.
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Auswirkung einer leitliniengerechten Behandlung auf die Mortalität bei Linksherzinsuffizienz. Herz 2016; 41:614-624. [DOI: 10.1007/s00059-016-4401-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/04/2016] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
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In-hospital management of acute heart failure: Practical recommendations and future perspectives. Int J Cardiol 2015; 201:231-6. [DOI: 10.1016/j.ijcard.2015.08.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/26/2015] [Accepted: 08/01/2015] [Indexed: 01/15/2023]
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Farmakis D, Parissis J, Lekakis J, Filippatos G. Insuficiencia cardiaca aguda: epidemiología, factores de riesgo y prevención. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.11.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Farmakis D, Parissis J, Lekakis J, Filippatos G. Acute heart failure: Epidemiology, risk factors, and prevention. ACTA ACUST UNITED AC 2015; 68:245-8. [PMID: 25659507 DOI: 10.1016/j.rec.2014.11.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/25/2014] [Indexed: 12/20/2022]
Abstract
Acute heart failure represents the first cause of hospitalization in elderly persons and is the main determinant of the huge healthcare expenditure related to heart failure. Despite therapeutic advances, the prognosis of acute heart failure is poor, with in-hospital mortality ranging from 4% to 7%, 60- to 90-day mortality ranging from 7% to 11%, and 60- to 90-day rehospitalization from 25% to 30%. Several factors including cardiovascular and noncardiovascular conditions as well as patient-related and iatrogenic factors may precipitate the rapid development or deterioration of signs and symptoms of heart failure, thus leading to an acute heart failure episode that usually requires patient hospitalization. The primary prevention of acute heart failure mainly concerns the prevention, early diagnosis, and treatment of cardiovascular risk factors and heart disease, including coronary artery disease, while the secondary prevention of a new episode of decompensation requires the optimization of heart failure therapy, patient education, and the development of an effective transition and follow-up plan.
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Affiliation(s)
- Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - John Parissis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - John Lekakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece.
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30
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Hemodynamic profiles of ED patients with acute decompensated heart failure and their association with treatment. Am J Emerg Med 2014; 32:302-5. [DOI: 10.1016/j.ajem.2013.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 11/28/2013] [Accepted: 12/02/2013] [Indexed: 01/11/2023] Open
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31
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Peacock WF, Chandra A, Char D, Collins S, Der Sahakian G, Ding L, Dunbar L, Fermann G, Fonarow GC, Garrison N, Hu MY, Jourdain P, Laribi S, Levy P, Möckel M, Mueller C, Ray P, Singer A, Ventura H, Weiss M, Mebazaa A. Clevidipine in acute heart failure: Results of the A Study of Blood Pressure Control in Acute Heart Failure-A Pilot Study (PRONTO). Am Heart J 2014; 167:529-36. [PMID: 24655702 DOI: 10.1016/j.ahj.2013.12.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/28/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Rapid blood pressure (BP) control improves dyspnea in hypertensive acute heart failure (AHF). Although effective antihypertensives, calcium-channel blockers are poorly studied in AHF. Clevidipine is a rapidly acting, arterial selective intravenous calcium-channel blocker. Our purpose was to determine the efficacy and safety of clevidipine vs standard-of-care intravenous antihypertensive therapy (SOC) in hypertensive AHF. METHODS This is a randomized, open-label, active control study of clevidipine vs SOC in emergency department patients with AHF having systolic BP ≥160 mm Hg and dyspnea ≥50 on a 100-mm visual analog scale (VAS). Coprimary end points were median time to, and percent attaining, a systolic BP within a prespecified target BP range (TBPR) at 30 minutes. Dyspnea reduction was the main secondary end point. RESULTS Of 104 patients (mean [SD] age 61 [14.9] years, 52% female, 80% African American), 51 received clevidipine and 53 received SOC. Baseline mean (SD) systolic BP and VAS dyspnea were 186.5 (23.4) mm Hg and 64.8 (19.6) mm. More clevidipine patients (71%) reached TBPR than did those receiving SOC (37%; P = .002), and clevidipine was faster to TBPR (P = .0006). At 45 minutes, clevidipine patients had greater mean (SD) VAS dyspnea improvement than did SOC patients (-37 [20.9] vs -28 mm [21.7], P = .02), a difference that remained significant up to 3 hours. Serious adverse events (24% vs 19%) and 30-day mortality (3 vs 2) were similar between clevedipine and SOC, respectively, and there were no deaths during study drug administration. CONCLUSIONS In hypertensive AHF, clevidipine safely and rapidly reduces BP and improves dyspnea more effectively than SOC.
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Affiliation(s)
| | | | | | | | | | - Li Ding
- The Medicine's Company, Parsippany, NJ
| | - Lala Dunbar
- Louisiana Health Sciences Center, New Orleans, LA
| | | | | | | | | | | | - Said Laribi
- Université Paris Diderot and Hospital Lariboisière, Paris, France
| | | | | | | | - Patrick Ray
- Tenon Hospital, University of Paris, Paris, France
| | | | | | - Mason Weiss
- Centinela Hospital Medical Center, Inglewood, CA
| | - Alex Mebazaa
- Université Paris Diderot and Hospital Lariboisière, Paris, France
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Abstract
Acute heart failure is a public health issue with morbidity and mortality exceeding that of myocardial infarction. Novel compounds for the treatment of acute heart failure are clearly needed and fall into the general categories of inotropic, vasodilatory and other compounds in phase I to III of development. Furthest along are omecamtiv mecarbil (a cardiac myosin activator), ularitide (a natriuretic and diuretic peptide) and relaxin (a vasodilator). Each compound has a unique set of assets and liabilities that will aid in the understanding of the syndrome and application to the right patients at the right time in this heterogeneous syndrome. This review will explore current and future novel pharmacologic therapies for the treatment of acute heart failure.
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Szmit S, Jank M, Maciejewski H, Balsam P, Majewska A, Loj M, Grabowski M, Filipiak KJ, Motyl T, Opolski G. White blood cell transcriptome correlates with renal function in acute heart failure. Int Heart J 2012; 53:117-24. [PMID: 22688316 DOI: 10.1536/ihj.53.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is notoriously difficult to classify patients with acute heart failure (AHF) because of variations in clinical presentation, different etiologies, the impact of comorbidities, and variable prognoses. In this study, we used DNA whole-genome microarrays to classify 24 patients with AHF based on the transcriptome of their peripheral blood nuclear cells. The main purpose was to verify whether any transcriptomic sub-clusters had clinical correlations. We identified two distinct groups of transcriptomic profiles that correlated with normal (1.125 mg/dL) and increased (1.783 mg/dL) mean blood creatinine concentrations. These two subgroups of patients (n = 12) differed in the expression of more than 6000 genes and 108 signaling pathways. The most significant regulated signaling pathway was the aldosterone-regulated sodium reabsorption pathway and the most significant regulated genes included the angiotensin-converting enzyme gene. This suggests that kidney impairment in patients with AHF is related to dysregulation of the renin-angiotensin-aldosterone system. The interesting findings of our study were the significant differences in expression of genes belonging to the aldosterone-regulated signaling pathway: Na<sup>+</sup>/K<sup>+</sup> transporting ATPase and NEDD4L (neuronal precursor cell expressed developmentally down-regulated 4-like) between patients with and without renal dysfunction. Future studies of blood-cell transcriptomic profiles in patients with AHF will provide further insights into the molecular pathogenesis of this cardiorenal disorder.
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Affiliation(s)
- Sebastian Szmit
- First Department of Cardiology, Medical University of Warsaw, Poland
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Differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with acute heart failure syndromes. Heart Vessels 2012; 28:345-51. [PMID: 22526380 DOI: 10.1007/s00380-012-0252-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 03/23/2012] [Indexed: 10/28/2022]
Abstract
While recent guidelines for the treatment of acute heart failure syndromes (AHFS) recommend pharmacotherapy with vasodilators in patients without excessively low blood pressure (BP), few reports have compared the relative efficiency of vasodilators on hemodynamics in AHFS patients. The present study aimed to assess the differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with AHFS. Thirty-eight consecutive patients were assigned to receive 48-h continuous infusion of carperitide (n = 19; 0.0125-0.05 μg/kg/min) or nicorandil (n = 19; 0.05-0.2 mg/kg/h). Hemodynamic parameters were estimated at baseline, and 2, 24, and 48 h after drug administration using echocardiography. After 48 h of infusion, systolic BP was significantly more decreased in the carperitide group compared with that in the nicorandil group (22.1 ± 20.0 % vs 5.3 ± 10.4 %, P = 0.003). While both carperitide and nicorandil significantly improved hemodynamic parameters, improvement of estimated pulmonary capillary wedge pressure was greater in the carperitide group (38.2 ± 14.5 % vs 26.5 ± 18.3 %, P = 0.036), and improvement of estimated cardiac output was superior in the nicorandil group (52.1 ± 33.5 % vs 11.4 ± 36.9 %, P = 0.001). Urine output for 48 h was greater in the carperitide group, but not to a statistically significant degree (4203 ± 1542 vs 3627 ± 1074 ml, P = 0.189). Carperitide and nicorandil were differentially effective in improving hemodynamics in AHFS patients. This knowledge may enable physicians in emergency wards to treat and manage patients with AHFS more effectively and safely.
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Minami Y, Kajimoto K, Sato N, Yumino D, Mizuno M, Aokage T, Murai K, Munakata R, Asai K, Sakata Y, Keida T, Hagiwara N, Mizuno K, Kasanuki H, Takano T. Admission time, variability in clinical characteristics, and in-hospital outcomes in acute heart failure syndromes: findings from the ATTEND registry. Int J Cardiol 2011; 153:102-5. [PMID: 21968075 DOI: 10.1016/j.ijcard.2011.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 09/06/2011] [Indexed: 11/25/2022]
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Peacock FW, Varon J, Ebrahimi R, Dunbar L, Pollack CV. Clevidipine for severe hypertension in acute heart failure: a VELOCITY trial analysis. ACTA ACUST UNITED AC 2010; 16:55-9. [PMID: 20412469 DOI: 10.1111/j.1751-7133.2009.00133.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute severe hypertension occurs in approximately 50% of patients with acute heart failure (AHF). Clevidipine, the latest-generation dihydropyridine calcium channel blocker, may be useful in the treatment of this patient population. The Evaluation of the Effect of Ultra-Short-Acting Clevidipine in the Treatment of Patients With Severe Hypertension (VELOCITY) trial enrolled 126 patients with systolic blood pressure (SBP) >180 mm Hg for treatment with clevidipine to a patient-specific prespecified initial target range (ITR) of SBP to be achieved within 30 minutes. Of the enrolled patients, 19 had AHF on presentation. Primary end points were the percentage in whom ITR was achieved within 30 minutes and the number whose SBP was below the ITR after 3 minutes of clevidipine infusion. Among the 19 AHF patients in VELOCITY, median time to ITR was 11.3 minutes (95% confidence interval, 7-19). ITR was reached in most patients (94%) within 30 minutes. No patient had hypotension below the ITR, and heart rate remained stable. At 18 hours, 16 of 19 patients had received continuous clevidipine infusion, and their SBP was reduced by mean of 50 mm Hg (25%) from baseline. There were no treatment-related adverse events or adverse events that led to clevidipine discontinuation. Clevidipine safely decreases SBP in AHF and does not cause unexpected hypotension. The results of this post hoc subgroup analysis suggest that clevidipine is safe, well tolerated, and efficacious in AHF patients with hypertension.
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Affiliation(s)
- Frank W Peacock
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH 44195-0001, USA.
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Gheorghiade M, Follath F, Ponikowski P, Barsuk JH, Blair JE, Cleland JG, Dickstein K, Drazner MH, Fonarow GC, Jaarsma T, Jondeau G, Sendon JL, Mebazaa A, Metra M, Nieminen M, Pang PS, Seferovic P, Stevenson LW, van Veldhuisen DJ, Zannad F, Anker SD, Rhodes A, McMurray JJ, Filippatos G. Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail 2010; 12:423-33. [DOI: 10.1093/eurjhf/hfq045] [Citation(s) in RCA: 513] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mihai Gheorghiade
- Center for Cardiovascular Quality and Outcomes; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Ferenc Follath
- Department of Medicine; University Hospital; Zürich Switzerland
| | | | - Jeffrey H. Barsuk
- Division of Hospital Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - John E.A. Blair
- Department of Cardiology; Wilford Hall Medical Center; San Antonio TX USA
| | - John G. Cleland
- Department of Academic Cardiology; University of Hull, Castle Hill Hospital; Hull UK
| | - Kenneth Dickstein
- Stavanger University Hospital; Stavanger Norway
- Institute of Internal Medicine; University of Bergen; Bergen Norway
| | - Mark H. Drazner
- University of Texas Southwestern Medical Center; Dallas TX USA
| | - Gregg C. Fonarow
- Division of Cardiology; University of California Los Angeles David Geffen School of Medicine; Los Angeles CA USA
| | - Tiny Jaarsma
- Department of Cardiology; University Hospital Groningen; Groningen The Netherlands
| | | | | | - Alexander Mebazaa
- Hospital Lariboisière; Paris France
- U942 INSERM; University Paris Diderot; Paris France
| | - Marco Metra
- Department of Cardiology; University of Brescia; Brescia Italy
| | - Markku Nieminen
- Department of Medicine, Section of Cardiology; Helsinki University Central Hospital; Helsinki Finland
| | - Peter S. Pang
- Department of Emergency Medicine and Center for Cardiovascular Quality and Outcomes; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Petar Seferovic
- Department of Cardiology II; University Institute for Cardiovascular Diseases; Belgrade Serbia
| | | | | | - Faiez Zannad
- Department of Cardiology; Campus Virchow-Klinikum, Charité Universitätsmedizin; Berlin Germany
| | - Stefan D. Anker
- Department of Cardiology; Campus Virchow-Klinikum, Charité Universitätsmedizin; Berlin Germany
| | - Andrew Rhodes
- Department of Intensive Care Medicine; St George's Hospital; London UK
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre; University of Glasgow; Glasgow Scotland UK
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology; Athens University Hospital Attikon; Rimini 1 12461 Haidari Athens Greece
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Metra M, Teerlink JR, Voors AA, Felker GM, Milo-Cotter O, Weatherley B, Dittrich H, Cotter G. Vasodilators in the treatment of acute heart failure: what we know, what we don't. Heart Fail Rev 2009; 14:299-307. [PMID: 19096932 PMCID: PMC2772958 DOI: 10.1007/s10741-008-9127-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Accepted: 11/25/2008] [Indexed: 12/13/2022]
Abstract
Although we have recently witnessed substantial progress in management and outcome of patients with chronic heart failure, acute heart failure (AHF) management and outcome have not changed over almost a generation. Vasodilators are one of the cornerstones of AHF management; however, to a large extent, none of those currently used has been examined by large, placebo-controlled, non-hemodynamic monitored, prospective randomized studies powered to assess the effects on outcomes, in addition to symptoms. In this article, we will discuss the role of vasodilators in AHF trying to point out which are the potentially best indications to their administration and which are the pitfalls which may be associated with their use. Unfortunately, most of this discussion is only partially evidence based due to lack of appropriate clinical trials. In general, we believe that vasodilators should be administered early to AHF patients with normal or high blood pressure (BP) at presentation. They should not be administered to patients with low BP since they may cause hypotension and hypoperfusion of vital organs, leading to renal and/or myocardial damage which may further worsen patients' outcome. It is not clear whether vasodilators have a role in either patients with borderline BP at presentation (i.e., low-normal) or beyond the first 1-2 days from presentation. Given the limitations of the currently available clinical trial data, we cannot recommend any specific agent as first line therapy, although nitrates in different formulations are still the most widely used in clinical practice.
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Affiliation(s)
- Marco Metra
- Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - John R. Teerlink
- Department of Cardiology, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA USA
| | - Adriaan A. Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G. Michael Felker
- Division of Cardiovascular Medicine, Duke Clinical Research Institute, Durham, NC USA
| | - Olga Milo-Cotter
- Momentum-Research Inc., 3100 Tower Blvd, Suite 802, Durham, NC 27707 USA
| | - Beth Weatherley
- Momentum-Research Inc., 3100 Tower Blvd, Suite 802, Durham, NC 27707 USA
| | | | - Gad Cotter
- Momentum-Research Inc., 3100 Tower Blvd, Suite 802, Durham, NC 27707 USA
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Peacock WF, Fonarow GC, Ander DS, Collins SP, Gheorghiade M, Kirk JD, Filippatos G, Diercks DB, Trupp RJ, Hiestand B, Amsterdam EA, Abraham WT, Amsterdam EA, Dodge G, Gaieski DF, Gurney D, Hayes CO, Hollander JE, Holmes K, Januzzi JL, Levy P, Maisel A, Miller CD, Pang PS, Selby E, Storrow AB, Weintraub NL, Yancy CW, Bahr RD, Blomkalns AL, McCord J, Nowak RM, Stomel RJ. Society of Chest Pain Centers recommendations for the evaluation and management of the observation stay acute heart failure patient—part 1. ACTA ACUST UNITED AC 2009; 11:3-42. [DOI: 10.1080/02652040802688690] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Optimizing heart failure management begins in the emergency department. Prompt recognition and treatment of underlying pathophysiology can improve patient outcomes. A review of therapeutic options is provided, with the goal of providing best practices in patient care.
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Affiliation(s)
- Preeti Jois-Bilowich
- Department of Emergency Medicine, University of Florida, Gainesville, FL 32610, USA.
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Guía de práctica clínica de la Sociedad Europea de Cardiología (ESC) para el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica (2008). Rev Esp Cardiol 2008. [DOI: 10.1016/s0300-8932(08)75740-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Filippatos G, Parissis JT. Vasopressin Antagonists for the Treatment of Acute Decompensated Heart Failure: When, for Whom, for How Long, and on What Standard Therapy? J Card Fail 2008; 14:648-50. [DOI: 10.1016/j.cardfail.2008.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Indexed: 10/21/2022]
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Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Tendera M, Auricchio A, Bax J, Bohm M, Corra U, della Bella P, Elliott PM, Follath F, Gheorghiade M, Hasin Y, Hernborg A, Jaarsma T, Komajda M, Kornowski R, Piepoli M, Prendergast B, Tavazzi L, Vachiery JL, Verheugt FWA, Zamorano JL, Zannad F. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29:2388-442. [PMID: 18799522 DOI: 10.1093/eurheartj/ehn309] [Citation(s) in RCA: 1956] [Impact Index Per Article: 122.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kenneth Dickstein
- University of Bergen, Cardiology Division, Stavanger University Hospital, Norway.
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ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10:933-89. [PMID: 18826876 DOI: 10.1016/j.ejheart.2008.08.005] [Citation(s) in RCA: 1326] [Impact Index Per Article: 82.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Peacock WF, Fonarow GC, Ander DS, Maisel A, Hollander JE, Januzzi JL, Yancy CW, Collins SP, Gheorghiade M, Weintraub NL, Storrow AB, Pang PS, Abraham WT, Hiestand B, Kirk JD, Filippatos G, Gheorghiade M, Pang PS, Levy P, Amsterdam EA. Society of Chest Pain Centers Recommendations for the evaluation and management of the observation stay acute heart failure patient: a report from the Society of Chest Pain Centers Acute Heart Failure Committee. Crit Pathw Cardiol 2008; 7:83-86. [PMID: 18520521 DOI: 10.1097/01.hpc.0000317706.54479.a4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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De Luca L, Mebazaa A, Filippatos G, Parissis JT, Böhm M, Voors AA, Nieminen M, Zannad F, Rhodes A, El-Banayosy A, Dickstein K, Gheorghiade M. Overview of emerging pharmacologic agents for acute heart failure syndromes. Eur J Heart Fail 2008; 10:201-13. [PMID: 18279775 DOI: 10.1016/j.ejheart.2008.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 11/15/2007] [Accepted: 01/02/2008] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several therapies commonly used for the treatment of acute heart failure syndromes (AHFS) present some well-known limitations and have been associated with an early increase in the risk of death. There is, therefore, an unmet need for new pharmacologic agents for the early management of AHFS that may improve both short- and long-term outcomes. AIM To review the recent evidence on emerging pharmacologic therapies in AHFS. METHODS A systematic search of peer-reviewed publications was performed on MEDLINE, EMBASE and Clinical Trials.gov from January 1990 to August 2007. The results of unpublished or ongoing trials were obtained from presentations at national and international meetings and pharmaceutical industry releases. Bibliographies from these references were also reviewed, as were additional articles identified by content experts. RESULTS Cumulative data from large studies and randomised trials suggest that therapies with innovative mechanisms of action may safely and effectively reduce pulmonary congestion or improve cardiac performance in AHFS patients. CONCLUSION Some investigational agents for the management of AHFS are able to improve haemodynamics and/or clinical status. In spite of these promising findings, no new agent has demonstrated a clear benefit in terms of long-term clinical outcomes compared to placebo or conventional therapies.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
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